Glucocorticoids in acute asthma. A critical controlled trial

Area of Science:

• Pulmonology
• Clinical Pharmacology
• Critical Care Medicine

Background:

• Severe acute asthma exacerbations often require intensive treatment.
• Patients refractory to initial therapy may have prolonged recovery.
• The efficacy of corticosteroids in such cases needs objective evaluation.

Purpose of the Study:

• To objectively assess the efficacy of intravenous hydrocortisone in severe acute asthma.
• To evaluate the time course of recovery in patients unresponsive to conventional therapy.

Main Methods:

• A randomized, double-blind, placebo-controlled trial was conducted.
• 20 subjects with severe acute asthma refractory to 8 hours of conventional therapy received either hydrocortisone infusion or placebo.
• Lung function (FEV1), pulmonary mechanics, and plasma cortisol levels were serially monitored over 24 hours.

Main Results:

• Hydrocortisone treatment led to significantly greater resolution of airway obstruction (FEV1 increase) compared to placebo.
• 50% of placebo recipients showed no improvement or deterioration in pulmonary mechanics.
• Arterial blood gases were unaffected, and plasma cortisol levels did not correlate with clinical improvement.

Conclusions:

• Parenteral hydrocortisone significantly speeds recovery in severe acute asthma patients unresponsive to standard treatment.
• Corticosteroids are effective in improving pulmonary function in refractory asthma.
• The study provides objective evidence for the role of corticosteroids in managing severe, persistent asthma exacerbations.